optoblog.com

To LASIK or not to LASIK...

I did this one because someone searched for “LASIK comic,” and I’m sure they were sadly disappointment that I didn’t have one.

Now before you get all over me for not spreading sunshine and lollipops about refractive surgery, let me first clarify that the above comic is comical, I thought. If I was told that my chance of winning the lottery was 99%, then I’d probably play it. If I was told that if I played the lottery that I had a 1% chance of dying then I wouldn’t play it.

I feel bad that I have to explain the resurrection reference, but I must make sure that those of you who never went to Sunday school understand that in the resurrection, our spirit will be reunited with our bodies which will be in a perfect form (our bodies, not us), so any LASIK disaster that plagued our days in mortality won’t bother our resurrected body.

My actual opinion regarding LASIK is pretty main stream. If someone really, really wants it and they have the proper medical prerequisites like cornea thickness, refractive error, good eye health, etc. AND they have a really good understanding of the risks and expectations, then I will recommend them to a good surgeon. Perhaps the surgeon that would do my LASIK if I wanted it.

But I don’t want it. I don’t fit the psychological profile since I’m perfectly happy in Night and Day contacts. I’m also rather wary of my family history since I’ve had three close blood relatives get it and most were left still needing glasses or enhancements.

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I think we should all consider going the route of “insurance free medicine.”
From guest blogger Dr. Mintz at Kevin, MD:

Thus, I think a term that I would like to propose for use in further discussions of newer ways of practicing primary care is “insurance free medicine.” The term “insurance free medicine” captures the essence of the newer models of primary care. Patients have certainly seen their premiums and deductibles increase and can probably relate quite well to reasons why a doctor would not accept insurance.

Insurance free primary care practices could certainly adopt retainer membership fees and promote improved access, but eliminating terms like “boutique,” “concierge,” and “cash only” might help eliminate the notion that primary medical care without insurance is somehow tainted or only for the super-wealthy. Previously, I discussed that without substantial changes, primary care will soon go the way of psychiatry in that patients who use their insurance to see a psychiatrist get one kind of care (very brief visits, mostly management by a non-physician) and those who pay their psychiatrist out-of-pocket get the kind of care that we see in TV and the movies.

With more frequent use of the term “insurance free medicine,” patients might start realizing that if they continue to pay their primary physician using their health care insurance, they should expect even briefer visits, longer waits to get in, seeing non-physicians, and greater delays getting a return phone call or results back.

I calculated the other day that I spent about $2000 a year to be set up and able to bill insurance. Further, I spent all that time and money for about 538 patients, or close to one-fourth of my patients per year. Now that Walmart no longer bills many vision plans for me, both numbers will go up, and so will my accounts receivable. In anticipation of this, my fee went up by $5 per patient at the beginning of the year.

I would lower my price if we could all convince the general public that routine medical office visits should be paid out of pocket. Your car insurance doesn’t pay for oil changes.

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The not so simple question...

There is a not-so-simple question that pretty much every patient asks, “How much is your eye exam.”

While the medical model has varying levels of exam, like Level II-New vs. Level IV-Est, which depend upon the history, exam, and complexity of that particular case; however, there are some among our profession that make it an especially hard question to answer, and this issue raises concern over the ethics of a fairly popular fee structure.

For example: the price in front of the Big Box says “Eye exams starting at $45!”
But are they really? Sure, for a “routine eye exam” where nothing is wrong and you just want your glasses updated, then it’s the $45. But what if I have some allergy eyes, so the doctor gives me a prescription for Pataday as well as my glasses Rx? All the sudden the exam somehow costs $120!?!?

Huh, something funny going on around here. I think big box doctors are more likely to do this since their exam fees are so low, they make up for it by gouging in other fees. I have no problem with a doctor who says their S0620 is $100 and their 92004 is $120. However, I think there is something wrong if the S0620 is $45 and the 92004 is $140.

It’s like some among us in the optometric profession are playing the windshield chip repairman scheme.

But what really happens? Patients won’t typically notice this bait-and-switch. It’s really the insurance companies who get hammered. The patient pays their copay, and if the doctor can come up with any excuse to bill a medical code, they use their medical model fee structure to justify it.

Ethics applies when we realize that, for some reason, private pay patients are rarely charged the same high fees as the insurance companies. Huh. Oh well. It’s a victimless crime because those big, bad insurance companies won’t miss the extra cash. Until we realize that the more insurance companies pay out, the more the patient’s premiums will be raised next year. Whoops. Sorry, Mrs. Smith, that you can’t afford to keep your medical insurance in the future because I wanted to get paid double or triple my usual fee because you have insurance today.

By the way, it cost me about $2000 to bill insurance last year (PIM software license, E-filing charges, and postage/paper for mailing statements/refunds). Also add to that the cost of time spent filing claims and handling overpayment and underpayment. If I didn’t have to deal with insurance, I could drop my exam fee by at least $5 per person.

I have an idea: All patients should pay for office visits out of pocket. If they have insurance, get reimbursed later. The doctor won’t know about their insurance, so there won’t be a conflict of interest about what exam fee structure he’ll choose. The doctor can lower his fees since filing claims is expensive and time consuming. Everyone wins. Another idea, insurances should allow me to charge either them or the patient a $5 claim filing service fee.

Take home point: I don’t believe it is ethical to have one fee structure for insurance patients and another drastically different one for private pay. Yes, I’m all for charging more money if something is more work and more time. That’s why a contact lens evaluation is paid on top of the routine eye exam. That’s why there are different levels of 99*** office visits. But sneaking a huge fee onto an insurance claim just because there is some medical code excuse is something I don’t think our profession should feel comfortable with.

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Clear vision isn't all it's cracked up to be.

It’s the return of the Optoblog comics! Comics are by far the most searched for items on my blog, so I’m just bowing to demand.

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• State senator in Utah proposes that we eliminate the 12 grade in our State! http://bit.ly/7qwTLM #

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I got my copy of the February 2010 National Geographic today (I have a fair and balanced waiting room: Guns and Ammo and National Geographic). There’s a big feature article about life in the FLDS church. On page 61 with the photo of the Jessop family offering a morning prayer, there is a small bottle on the sink counter-top in the background, and I’m pretty sure it’s a bottle of Systane Ultra.

I’d post the picture, but I’m not sure if I’d get sued by NG, so just go find a copy and tell me if you think it’s some other eye drop brand.

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• Went to Texas Roadhouse and waited 1:40 to be seated. Food is only worth about a 0:20 wait. #

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In Answers to Your Search Questions Part 1, Part 2, and Part 3, I pithily answered the questions on your mind as indicated by the web search that brought you to my site.

Just to review, I know what IP address you have and the URL that was in your address bar just before coming to my website. A search URL contains the search term that you used. So let’s see what everyone is curios about!

1. “how to become a millionaire optometrist” – Ha ha ha ha ha. Wow, that’s funny… Huh? Your serious? Well, I guess the only way I’ve heard of is starting your own consulting company and charging other suckers optometrists tens of thousands of dollars to blow smoke up their
2. “get rich in optometry” – See above. Man, what is the deal with all these capitalist pigs thinking they can be a doctor AND be rich? Haven’t they drank the Obama juice yet?
3. “contact lens comic” – Let me put in yet another plug for my fine body of work as a cartoonist.
4. “going to vet school after being an optometrist” – If working in healthcare for human beings didn’t work out for you, what makes you think dogs and cats will pay you any better? They don’t have checking accounts or credit cards.
5. “what should I expect after optometry school” – Oh Lordy, I don’t envy you. Let’s see…where do I start? First, get yourself a temp job packing frozen dinners until your license comes in July. If you applied for a government job don’t expect to start work until October. If you want to work a chain store, expect to fill-in at different places for a while until you find an opening in a town you actually want to live in. When you work for another O.D., expect to be paid half what you bring in. Expect to pay a whole bunch of money in business insurance, professional liability insurance, general liability insurance, student loan repayment, business loan repayment, rent, wages, and on and on until you bring home so little bacon, it’s actually just a sprinkle of bacon bits…and they’re actually made out of soy.
6. “How the FCLCA has decreased costs in contact lenses” – Good question. I know how it’s raised profits for online retailers. Theoretically, the more retailers there are, the more competition there is. More competition breeds price wars. Price wars make retail price go down. Of course, in practice, the first thing Walmart did when they joined 1800Contacts was raise most of their contact lens prices to match 1800’s pricing structure. Anybody have a good answer to this question?
7. “easiest optometry school” – Again, people keep asking this question. If I were an optometry school, I would set up a honey pot site so that anyone asking this question would probably get referred to the honey pot from a search result. Log all the information you can (IP address, location info, etc) and compare it to their logs of people requesting information from the optometry school website. Then make a “do not interview” list based on the database cross references.
8. “the best and worst optometrist that you have worked for” – I’m pretty sure no one would really post actual names since you don’t want to get sued for something, but I’d stay clear of any practice that seems to hire an O.D. for a couple years, promising them a buy-in option, but then they renege so the new O.D. leaves.
9. “how much does it cost to start an optometric practice” – as much as a house.
10. “doctors melton and thomas” – They’re awesome. As far as I’m concerned, drug reps don’t have to visit me since I’m just gonna do whatever Drs. Melton and Thomas say.
11. “1800contacts sending contacts without dr verification” – Well, if you don’t respond to their fax and/or phone call, then they have to assume what the patient told them is correct.
12. “i hate science, but i want to become an optometrist” – If by “science” you mean this whole global cooling- I mean warming- I mean climate change fraud, then I agree. If you mean true science, then I’m not sure I can help you. But I will suggest you do an internet search for the easiest optometry school to get into and maybe you’ll get through it.
13. “what should you major in if you want to get to optometry school?” – anything you want, but you’ll have to take all the prerequisite classes also. Since most people want to leave undergrad in four or five years, this usually involves having to major in some biological science. I think it would be cool if more optometrists majored in business or marketing and then minored in the biology. But I hate those majors, so that’s why I didn’t go that route. Do what you love.
14. “optometrist strategies in 2010” – I heard Sam’s club or its doctors are going to try to give $20 exam rebates to patients, but I don’t know the reasoning behind it. No one likes rebates. Instant rebates might fly, but then, why not have your fee be your fee? I didn’t major in marketing so you better not ask me.

This concludes Part 4. Keep searching!

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I would just like to ask every Walmart optometrist reading this blog to please nominate me to go to the Health & Wellness Conference May 3-5th, 2010 in Bentonville Arkansas. I want to be one of the 250 optometrists in attendance.

To nominate me, find the e-mail that was sent to you from Walmartod.com on 1-8-2010 and click on the link. Here is the information you will need:

David Langford
Store # 1888
North Logan, UT

Why should you nominate me?

• Because I guess you can’t nominate yourself.
• I’m a cub scout Wolf den leader. I go to church every Sunday
• The associates in my vision center like me- we’re even friends on Facebook.
• I’m all techie. I even have a Humphrey Matrix VF and HRT2 in my office.
• I recently raised my fees and no longer charge extra for dilation.
• I was featured in the Review of Optometry with an article highlighting Walmart optometry.
• I’m like one of the original optometry bloggers. ‘Nuff said. I’ll blog the whole thing so it’s just like you being there (except without having to lose money while not doing exams at your office.)

There you have it. All the reasons you need.

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I think this product is great.

Let’s hope 80-year-olds are computer savvy these days. I think this product could really help, but I also think there are some big hurtles to overcome:

• How much is this thing gonna cost?
• How much will it cost to train grandma and grandpa to do it?
• How much will the doctor charge to review the results every time it’s done?

I think you’re going to need a really motivated, affluent, tech savvy patient who is not in denial about their AMD for this machine to be viable.

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